Methods and compositions for mitochondrial replacement therapy

ABSTRACT

The invention features methods, kits, and compositions for mitochondrial replacement in the treatment of disorders arising from mitochondrial dysfunction. The invention also features methods of diagnosing neuropsychiatric (e.g., bipolar disorder) and neurodegenerative disorders based on mitochondrial structural abnormalities.

BACKGROUND OF THE INVENTION

Mitochondria are essential organelles in plant and animal cells thatarise from a prokaryotic ancestor and play a key role in processes suchas oxidative phosphorylation, aerobic metabolism of glucose and fat,calcium signaling, and apoptosis (Wallace, Proc. Natl. Acad. Sci. USA91:8739 (1994) and Dyall et al., Science 304:253 (2004)). The humanmitochondrial genome is 16,568 bp and encodes a limited number ofmitochondria-specific proteins, rRNAs, and tRNAs (Brandon et al.,Nucleic Acids Res. 33:D611 (2005)). All other mitochondrial proteins areencoded in the nucleus. The mitochondrial genome is maternally inheritedand undergoes a high rate of mutation because mtDNA is not protected byhistones, is inefficiently repaired (Mason et al., Nucleic Acids Res.31:1052 (2003)), and is exposed to oxygen radicals generated byoxidative phosphorylation (Wallace, Proc. Natl. Acad. Sci. USA 91:8739(1994)).

A large number of heritable diseases are caused by mutations that arefound in mitochondrial and nuclear genes encoding mitochondrial proteinsand that produce heritable skeletal or cardiac myopathies (Wallace,Proc. Natl. Acad. Sci. USA 91:8739 (1994), Brandon et al., Nucleic AcidsRes. 33:D611 (2005), Wallace, Science 283:1482 (1999), and Green et al.,Science 305:626 (2004)). In addition, environmentally-induced mutationsin mtDNA have been implicated in many common acquired disorders,including ischemic diseases of the heart and brain, neurodegenerativediseases, some liver diseases, and some cancers (Wallace, Science283:1482 (1999)). For example, disorders involved in mitochondrialdysfunction affecting cellular processes include but are not limited toneuropsychiatric diseases such as bipolar disorder (BD), depression,schizophrenia, and Rett's syndrome; neurodegenerative disease likeAlzheimer's disease, Parkinson's disease, Friedreich's ataxia (and otherataxias); amyotrophic lateral sclerosis (ALS) (and other motor neurondiseases); Huntington's disease; and various neuropathies andmyopathies, such as Leber's hereditary optic neuropathy (LHON),encephalopathy, lactacidosis, stroke (MELAS); myoclonic epilepsy withragged red fibers (MERFF); macular degeneration; epilepsy; andmitochondrial myopathy.

The use of antioxidants targeted to mitochondria, which has been shownto be effective at slowing disease progression, has been reported byJauslin et al., (FASEB J. 17:1972 (2003)). Therapeutic benefit ofadministering γ-tocopherol derivatives and metabolites as antioxidantsand nitrogen oxide scavengers which treat high blood pressure,thromboembolic diseases, cardiovascular disease, cancer, natriureticdisease, formation of neuropathological lesions and reduced immunesystem response are disclosed in U.S. Pat. Nos. 6,555,575; 6,242,479;6,150,402; and 6,410,589. The use of certain chroman derivatives incosmetic and dermatological preparations is disclosed in U.S. PatentPublication No. 2002/0127252. The beneficial effects of Vitamin E in theprogression of a number of major degenerative diseases of the nervoussystem has been examined in Fryer, Nutritional Neuroscience 1:327(1998).

Numerous attempts have been made to treat disease associated withmitochondrial dysfunction using transplanted tissues or cells. Attemptsto treat such diseases with replacement cells can be complicated by thenecessity of replacing diseased tissue rather than improving thefunction of existing cells and tissue.

The present invention addresses the need for new therapies forconditions characterized by mitochondrial dysfunction without thereplacement of existing cells. The invention also features methods ofdiagnosing neuropsychiatric (e.g., bipolar disorder) andneurodegenerative disorders based on mitochondrial structuralabnormalities.

SUMMARY OF THE INVENTION

Applicants have discovered methods, kits, and compositions formitochondrial replacement in the treatment of disorders arising frommitochondrial dysfunction. Applicants also have discovered methods ofdiagnosing neuropsychiatric (e.g., bipolar disorder) andneurodegenerative disorders associated with mitochondrial dysfunctionbased on mitochondrial structural abnormalities.

Accordingly, in a first aspect the invention features a method forimplanting mitochondria in vivo into cells of a subject by administeringto the subject isolated and substantially pure mitochondria.

In a related aspect, the invention features a method for increasing therespiratory ability of a cell in a subject by administering to thesubject isolated and substantially pure mitochondria in an amountsufficient to increase the respiratory ability of the cell.

In another aspect, the invention features a method of improving musclefunction in a subject by administering to the subject isolated andsubstantially pure mitochondria in an amount sufficient to improvemuscle function.

The invention further features a method of treating a conditionassociated with mitochondrial dysfunction in a subject in need thereofby administering to the subject isolated and substantially puremitochondria in an amount sufficient to treat the condition.

In an embodiment of the methods of the invention, the methods includethe steps of (i) separating mitochondria from other constituents of acell to produce isolated and substantially pure mitochondria; and (ii)administering the isolated and substantially pure mitochondria into thesubject. In certain embodiments, the cells are progenitor cells or anyother cell type described herein.

The isolated and substantially pure mitochondria can be administeredsystemically (e.g., intranasally, intramuscularly, subcutaneously, orintravenously) or can be administered locally. The route ofadministration used in the methods of the invention can be any routedescribed herein.

In still other embodiments of the methods of the invention, the methodsfurther include administering to the subject one or more agents selectedfrom vitamin A, vitamin C, vitamin D, vitamin E, vitamin K, folic acid,choline, vitamin B1, vitamin B2, vitamin B5, vitamin B6, vitamin B12,biotin, nicotinamide, betacarotene, coenzyme Q, selenium, superoxidedismutase, glutathione peroxide, uridine, creatine succinate, pyruvate,dihydroxyacetone), acetyl-L-carnitine, alpha-lipoic acid, cardiolipin,omega fatty acid, lithium carbonate, lithium citrate, calcium, andmixtures thereof, such as the cocktails described herein.

In another aspect, the invention features a pharmaceutical compositionincluding (i) isolated and substantially pure mitochondria; (ii) apharmaceutically acceptable excipient; and (iii) one or more compoundsselected from vitamin A, vitamin C, vitamin D, vitamin E, vitamin K,folic acid, choline, vitamin B₁, vitamin B₂, vitamin B₅, vitamin B₆,vitamin B₁₂, biotin, nicotinamide, betacarotene, coenzyme Q, selenium,superoxide dismutase, glutathione peroxide, uridine, creatine succinate,pyruvate, dihydroxyacetone), acetyl-L-carnitine, alpha-lipoic acid,cardiolipin, omega fatty acid, lithium carbonate, lithium citrate,calcium, and mixtures thereof, such as the cocktails described herein.

In still another aspect, the invention features a kit including (i)isolated and substantially pure mitochondria and (ii) instructions foradministering said mitochondria to a subject.

The invention also features a kit including (i) isolated andsubstantially pure mitochondria and (ii) instructions for administeringsaid mitochondria to a subject for the treatment of a conditionassociated with mitochondrial dysfunction.

In an embodiment of the kits of the invention, the kits includemitochondria formulated with a pharmaceutically acceptable excipient andone ore more compounds selected from vitamin A, vitamin C, vitamin D,vitamin E, vitamin K, folic acid, choline, vitamin B₁, vitamin B₂,vitamin B₅, vitamin B₆, vitamin B₁₂, biotin, nicotinamide, betacarotene,coenzyme Q, selenium, superoxide dismutase, glutathione peroxide,uridine, creatine succinate, pyruvate, dihydroxyacetone),acetyl-L-carnitine, alpha-lipoic acid, cardiolipin, omega fatty acid,lithium carbonate, lithium citrate, calcium, and mixtures thereof, suchas the cocktails described herein.

In any of the above aspects, the mitochondria can be syngeneicmitochondria, allogeneic mitochondria, or xenogeneic mitochondria. Themitochondria for use in the methods, kits, and compositions of theinvention can be obtained from any source described herein.

In any of the above aspects, the condition associated with mitochondrialdysfunction can be selected from, without limitation, aneurodegenerative disorder (e.g., Friedrich's ataxia, amyotrophiclateral sclerosis, mitochondrial myopathy, encephalopathy, lactacidosis,stroke (MELAS), myoclonic epilepsy with ragged red fibers (MERFF),epilepsy, Parkinson's disease, Alzheimer's disease, or Huntington'sDisease), a neuropsychiatric disorder (e.g., bipolar disorder,schizophrenia, depression, addiction disorders, anxiety disorders,attention deficit disorders, personality disorders, autism, orAsperger's disease), diabetes, metabolic disease, an ocular disorderassociated with mitochondrial dysfunction (e.g., glaucoma, diabeticretinopathy or age-related macular degeneration), an ischemia relatedcondition (e.g., a condition resulting from vascular occlusion,tachycardia, hypotension, or sickle cell disease), aging, mitochondrialtoxicity associated with therapeutic agents, or migraine. The conditionassociated with mitochondrial dysfunction can be any condition, disease,or disorder described herein.

In another aspect, the invention features a method of diagnosing aneuropsychiatric or neurodegenerative disorder associated withmitochondrial dysfunction in a subject by (i) determining whethermitochondria within a cell present in a tissue sample extracted from thesubject contain a mitochondrial structural abnormality; and (ii) if themitochondrial structural abnormality exists, diagnosing the subject ashaving, or being at risk of developing, the disorder.

In a related aspect, the invention features a method of diagnosing aneuropsychiatric or neurodegenerative disorder associated withmitochondrial dysfunction in a subject by (i) identifying whether asubject is at risk of having or developing the disorder; and (ii)determining whether mitochondria within a cell present in a tissuesample extracted from the subject contain a mitochondrial structuralabnormality characteristic of the disorder.

The invention further features a method of diagnosing a neuropsychiatricor neurodegenerative disorder associated with mitochondrial dysfunctionby (i) identifying whether a mitochondrial structural abnormality existsin a cell present in a tissue sample extracted from the subject; and(ii) on the basis of the results of step (i), reporting to a physicianwhether the subject has a mitochondrial structural abnormalitycharacteristic of the disorder.

In the diagnostic methods of the invention the neuropsychiatric orneurodegenerative disorder associated with mitochondrial dysfunction canbe, for example, a neuropsychiatric disorder selected from bipolardisorder, schizophrenia, depression, addiction disorders, anxietydisorders, attention deficit disorders, personality disorders, autism,Asperger's disease, and any other neuropsychiatric disorder describedherein. In certain embodiments, the neuropsychiatric orneurodegenerative disorder associated with mitochondrial dysfunction canbe, for example, a neurodegenerative disorder selected from Friedrich'sataxia, amyotrophic lateral sclerosis, mitochondrial myopathy,encephalopathy, lactacidosis, stroke (MELAS), myoclonic epilepsy withragged red fibers (MERFF), epilepsy, Parkinson's disease, Alzheimer'sdisease, Huntington's Disease, and any other neurodegenerative disorderdescribed herein.

In certain embodiments of the diagnostic methods of the invention, thetissue sample extracted from the subject does not include nervoustissue. For example, the tissue sample can be, without limitation, ablood sample. The cell extracted from the tissue sample can be, forexample, a lymphocyte (e.g., a T cell, B cell, or NK cell), or afibroblast.

In the diagnostic methods of the invention the mitochondrial structuralabnormality can include, without limitation, one or more of thefollowing: mitochondrial perinuclear aggregation or clustering, reducedpresence or absence of mitochondria in the cellular periphery, reducedaverage mitochondrial perinuclear distance, increased mitochondrialclustering, punctate, cup-shaped or ring-shaped mitochondria, longer orcondensed mitochondrial profiles that include large intercristae spacesand narrow junctions between cristae, and reduced mitochondrialbranching.

As used herein, the term “isolated and substantially pure mitochondria”refers to a composition containing mitochondria separated from othercellular constituents in which the combined mass of thenon-mitochondrial cellular constituents are less than 5%, 4%, 3%, 2%,1%, 0.5%, or 0.1% of the mass of the mitochondria in the isolated andsubstantially pure mitochondria-containing composition. Mitochondria canbe isolated and purified using any methods known in the art, includingthose described herein.

As used herein, the term “neurodegenerative disorder” refers to diseasesof the nervous system (e.g., the central nervous system or peripheralnervous system) characterized by abnormal cell death. Examples ofneurodegenerative disorders include Alzheimer disease, Down's syndrome,Frontotemporal dementia, Niemann-Pick's disease, Parkinson's disease,Huntington's disease (HD), dentatorubropallidoluysian atrophy, Kennedy'sdisease (also referred to as spinobulbar muscular atrophy), andspinocerebellar ataxia (e.g., type 1, type 2, type 3 (also referred toas Machado-Joseph disease), type 6, type 7, and type 17)), fragile X(Rett's) syndrome, fragile XE mental retardation, Friedreich's ataxia,myotonic dystrophy, spinocerebellar ataxia type 8, and spinocerebellarataxia type 12, Alexander disease, Alper's disease, amyotrophic lateralsclerosis, ataxia telangiectasia, Batten disease (also referred to asSpielmeyer-Vogt-Sjogren-Batten disease), Canavan disease, Cockaynesyndrome, corticobasal degeneration, Creutzfeldt-Jakob disease, ischemiastroke, Krabbe disease, Lewy body dementia, multiple sclerosis, multiplesystem atrophy, Pelizaeus-Merzbacher disease, Pick's disease, primarylateral sclerosis, Refsum's disease, Sandhoff disease, Schilder'sdisease, spinal cord injury, spinal muscular atrophy,Steele-Richardson-Olszewski disease, and Tabes dorsalis.

By “neuropsychiatric disorder” is meant disorders of the nervous systemby both neurologic and psychiatric abnormalities. Neuropsychiatricdisorders include, without limitation, bipolar disorder; schizophrenia;affective disorders, such as depression, addictive disorders, anxietydisorders, attentional disorders, and personality disorders; anddisorders of childhood development, such as autism and Asperger'sdisease.

As used herein, the term “ischemia related condition” refers toconditions characterized by insufficient blood supply to a tissue ororgan and which can result in damage or dysfunction of the tissue ororgan (e.g., heart, brain, intestine, liver, kidney, muscle, and eye),and can be due to any number of causes including, for example, vascularocclusion (caused by, e.g., athero-arteriosclerosis, plaque formation orthrombosis), tachycardia, hypotension, sickle cell disease, or otherinjury).

“Marrow-derived adult progenitor cells” or “MAPCs” refer to a populationof specialized mesenchymal cells in the adult bone marrow that give riseto mesoderm, endoderm, neuroectoderm, and skin, and exhibit many of thesame traits as embryonic stem cells.

Mitochondria for use in the methods, kits, and compositions of theinvention can be obtained from a variety of sources and can beclassified according to the genetic relationship between themitochondrial source and the subject being treated. As used herein,“allogeneic mitochondria” refers to mitochondria obtained from samespecies, but a different genotype than that of the subject receivingtreatment; “syngeneic mitochondria” refers to mitochondria obtained fromsame species and having the same genotype as that of the subjectreceiving treatment; and “xenogeneic mitochondria” refers tomitochondria obtained a different species than the subject beingtreated.

By “mitochondrial structural abnormalities” is meant any morphologicalor spatial characteristic in a mitochondrion, or distributioncharacteristic of mitochondria within a cell, that is not observed inthe cells (e.g., fibroblasts or lymphocytes) of healthy subjects.Abnormalities can occur in a single mitochondrion, or in the spatialgrouping or arrangement of a plurality of mitochondria within a cell.Mitochondrial structural abnormalities include, but are not limited to,mitochondrial perinuclear aggregation or clustering, increasedmitochondrial clustering, punctate, cup- or ring-shaped mitochondria,longer or condensed mitochondrial profiles that include largeintercristae spaces and narrow junctions between cristae, and reducedmitochondrial branching.

By “perinuclear aggregation” or “perinuclear clustering” is meant anabnormal distribution of mitochondria within a cell characterized by areduction in the mitochondrial numerical density at the periphery of thecell (e.g., 60-100 μm from the nucleus) in comparison to thedistribution observed in a cell from a healthy subject (see FIG. 8e ).

As used herein, “identifying a subject at risk” refers to identifying asubject in need of a diagnosis, or confirmation of a diagnosis, ashaving, or being likely to develop, a neuropsychiatric orneurodegenerative disorder associated with mitochondrial dysfunction.Such a subject is identified using methods other than those describedherein (i.e., methods that do not include assessing whether the cells ofthe subject include mitochondrial structural abnormalities). Any one ormore of a variety of techniques known in the art can be used. Forexample, a subject at risk may be identified by symptoms exhibited bythe subject, by genetic testing, and/or by family history. Thediagnostic methods of the invention can be used, alone or in combinationwith these other methods, to diagnose (or to confirm a diagnosis of) aneuropsychiatric or neurodegenerative disorder associated withmitochondrial dysfunction in a subject at risk of having or developingsuch a condition.

“Treating” and “treatment” refer to reduction in severity, progression,spread, and/or frequency of symptoms, elimination of symptoms and/orunderlying cause, prevention of the occurrence of symptoms and/or theirunderlying cause, and improvement or remediation of damage. “Treatment”is meant to include therapeutic treatment as well as prophylactic, orsuppressive measures for the condition, disease or disorder.

As used herein, the terms “an amount sufficient” and “sufficient amount”refer to the amount of isolated and substantially pure mitochondria ofthe invention required to treat or prevent a condition associated withmitochondrial dysfunction. The sufficient amount used to practice theinvention for therapeutic or prophylactic treatment of conditions causedby or contributed to by mitochondrial dysfunction can vary dependingupon the manner of administration, the age, body weight, and generalhealth of the subject. Ultimately, the attending physician will decidethe appropriate amount and dosage regimen. Such amount is referred to asa “sufficient” amount.

By “subject” is meant any animal (e.g., a human). Other animals that canbe treated using the methods, compositions, and kits of the inventioninclude horses, dogs, cats, pigs, goats, rabbits, hamsters, monkeys,guinea pigs, rats, mice, lizards, snakes, sheep, cattle, fish, andbirds.

By “pharmaceutical composition” is meant a composition containingisolated and substantially pure mitochondria formulated with apharmaceutically acceptable excipient, and which is manufactured andmarketed in compliance with the requirements of a governmentalregulatory agency as part of a therapeutic regimen for the treatment orprevention of disease in a mammal. Pharmaceutical compositions can beformulated, for example, for intravenous administration (e.g., as asuspension of mitochondria in a solvent system suitable for in vivoinjection), or any other formulation and for any other route ofadministration described herein.

“Increasing respiratory ability” refers to increasing the efficiency ofcoupling between phosphorylation and oxygen consumption in a cell. Anincrease in respiratory ability can be observed by measuring in vivo O₂consumption and ATP synthesis rates using the methods described inMarcinek, Acta Physiologica Scandinavica 182: 343 (2004) before andafter mitochondrial replacement therapy.

Other features and advantages of the invention will be apparent from thefollowing detailed description, the drawings, and the claims.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a photograph depicting active mitochondria isolated from adultbone marrow derived cells.

FIG. 2 is a photograph showing that fibroblasts from patients withbipolar disorder exhibit abnormalities in mitochondrial structure (seeFIG. 2a vs. FIG. 2b ). Mitochondria from human BD fibroblasts show analtered morphology consisting of short, thickened profiles that arearranged in a predominantly perinuclear location compared to age-matchedcontrols. The transplantation of healthy mitochondria to BD fibroblastsrestores the normal mitochondrial distribution and morphologic phenotype(see FIG. 2c vs. FIG. 2d ).

FIG. 3 is a photograph depicting (FIG. 3a ) the distribution of liposomepackaged mitochondria in adult mouse liver. Yellow fluorescent protein(YFP)-tagged mitochondrial isolates were obtained fresh from normalhuman fibroblasts infected with a replication defective herpes simplexviral (HSV) 1 vector encoding a fusion of YFP and a human mitochondrialtargeting sequence. Animals were injected one time intravenously with150 μl of purified mitochondrial pellet suspended in saline; (FIG. 3b )liver distribution of liposome packaged mitochondria after intramuscularadministration; and (FIG. 3c ) liver distribution of liposome vehicle(without mitochondria) after intramuscular administration (nofluorescence is observed). The systemic administration of mitochondriaresults in uptake of mitochondria by cells of the liver.

FIG. 4 is a photograph depicting (FIG. 4a ) brain distribution in adultmouse brain of liposome packaged mitochondria following intravenousadministration; and (FIG. 4b ) brain distribution of liposome packagedmitochondria after intramuscular administration. The systemicadministration of mitochondria results in uptake by cells of the brain.

FIG. 5 is a photograph showing that neurons of patients with BD displayalterations in mitochondrial shape. Representative ultrastructuralimages of the prefrontal cortex show the atypical mitochondrialmorphology and distribution (FIG. 5c-h ) in neurons from patients withBD compared to those from age-matched controls (FIGS. 5a and b ). Inbrains from patients with BD, many mitochondria appeared as cup-shapedor circular profiles (FIGS. 5d and f-h , arrows) with distendedintercristae spaces (FIG. 5d inset and 5 e, arrows) compared tomitochondria in healthy controls (FIG. 5b insets). The low magnificationimages in FIGS. 5a and 5c highlight the perinuclear clustering ofmitochondria in the BD patients (FIG. 5c , arrows) in contrast to thedispersed mitochondrial profiles in control patients (FIG. 5a , arrows).FIGS. 5a and 5c , bar=2 μm; FIGS. 5b and 5d , bar=500 nm; FIG. 5b rightinset and 5 e, bar=500 nm; FIG. 5b left inset and 5 d inset, bar=1 μm;and FIGS. 5f-h , bar=500 nm.

FIG. 6 is a photograph showing mitochondrial clustering in primary cellsfrom patients with BD. Compared to control cells, (FIGS. 6a and e ,arrows), mitochondrial morphology and distribution were dramaticallyaltered in primary fibroblasts (FIG. 6b , arrows) and lymphocytes (FIG.6f , arrow) from patients with BD. In the majority (greater than 90%) ofthese cells, perinuclear clusters revealed using Mitotracker 7510fluorescence, were observed. The clusters varied in size and were oftencomposed of ring-shaped or circular mitochondrial profiles. Fibroblastsfrom patients with PD (FIGS. 6c and d ) with known mitochondrial DNAdefects, display mitochondrial fragmentation (arrows) but do not exhibitthe extensive clustering seen in cells from the BD patients. Panels 6a-f, bar=10 μm.

FIG. 7 is a photograph showing ultrastructural alterations inmitochondrial morphology in peripheral cells from patients with BD. ByEM, mitochondria in lymphocytes and fibroblasts from healthy controlsubjects (FIGS. 7a and b , arrows) were distributed randomly throughoutthe cytoplasm. By comparison, lymphocytes and fibroblasts from patientswith BD (FIGS. 7c and d , arrows) showed mitochondria collapsed andclustered close to the nucleus—consistent with the light microscopicfindings (compare with FIGS. 6b and f). Mitochondrial profiles in thesecells showed little evidence of branching. As in neurons, mitochondrialprofiles in cultured cells from the subjects with BD were predominantlyarranged in perinuclear clusters, in contrast to the dispersedmitochondrial network in cells from healthy subjects and were oftenring-, or cup-shaped, or, less frequently, circular (FIGS. 7g and h ,arrows). Cristae were swollen or ill-defined (FIG. 7f-h , arrows)compared to healthy controls (FIG. 7e ). FIG. 7a-d , bar=10 μm; FIG.7e-h , bar=10 μm.

FIG. 8 is a photograph showing mitochondrial distribution in fibroblastsfrom control and BD individuals. Representative images of fibroblastsfrom patients with BD (FIG. 8b ) and control (FIG. 8a ) labeled withprobes for mitochondria (green, Mitotracker 7510) and filamentous actin(red, phalloidin) show the dramatic mitochondrial redistribution andperinuclear clustering in the BD fibroblasts compared with controls. Wefound that in cells from BD individuals (FIG. 8b-d ), abnormalities inmitochondrial shape (arrows) and distribution were not accompanied bycytoskeleton changes when compared to healthy controls (FIG. 8a ). Inaddition, fluorescent staining of fibroblasts with the DNA-binding dyes,DAPI or bisbenzimide (blue label), revealed no evidence of apoptosis ornuclear fragmentation in the BD cells. FIG. 8e : Morphometric analysisof spatial distribution in mitochondria identified in fibroblasts withMitotracker 7510 (green, arrows) from normal controls (n=6) (see FIG. 8a) and patients with BD (n=6) (see FIGS. 8b and e left panel, arrow).Concentric annuli the shape of each nuclear envelope were placed at thecentroids of each nucleus (FIG. 8e , middle panel, “bull's eye” for asingle cell) to cover the spatial extents of each fibroblast. Our imagesegmentation algorithm measured mitochondrial numerical densityobjectively as a function of perinuclear distance from the envelope onthe logarithmic scale (FIG. 8e , right panel, for an example BD andhealthy control cell); raw data were too noisy to display for all cells,images and subjects to reveal any suspected density gradients in theensemble. However, all BD cells exhibited positive mitochondrialdensities at a maximum perinuclear distance of 60 μm, as shown; for allhealthy cells this maximum distance was 100 μm, as shown. Our randomeffects analysis of covariance, that included the main effects ofperinuclear distance, diagnostic group and the group by distanceinteraction, revealed the suspected underlying mitochondrial densitydifferences between the BD and healthy control groups. The BD groupexhibited significantly less decline in numerical densities atperinuclear distances proximal to the nuclear envelope than those seenin healthy subjects (ANCOVA t-value 2.62, p=0.008). FIG. 8a-e , bar=10μm.

FIG. 9 is a photograph showing the loss of mitochondrial function infibroblasts from patients with BD. Staining of live, unfixed fibroblastswith JC-1 revealed loss of the red J-aggregate fluorescence and thecytoplasmic diffusion of the green monomeric fluorescence in individualswith BD (FIGS. 9b and d ) indicating collapse of mitochondrial membranepotential compared with normal controls (FIGS. 9a and c ). Highermagnification photomicrographs of cells from controls (FIG. 9c ) and BDindividuals (FIG. 9d ) visualized by fluorescence microscopy showregions of high mitochondrial polarization due to red aggregatefluorescence by the concentrated dye (arrows). Depolarized regions ofthe mitochondrial membrane are indicated by the green fluorescence ofthe JC-1 monomers (FIGS. 9c and d , arrowheads). FIGS. 9a and b , bar=50μm; FIGS. 9c and d , bar=10 μm. ATP levels measured by luciferase assay(FIG. 9e ) shows 2.4-fold lower levels of ATP in fibroblasts fromsubjects with BD (n=6) compared to healthy control fibroblasts (n=6)(Control fibroblasts, no treatment—mean=9.02×10⁻⁴, SE 2.3×10⁻⁴; BDfibroblasts, no treatment—mean=3.8×10⁻⁴, SE 5.4×10⁻⁵; p<0.05). FIGS. 9aand b , bar=50 μm; FIGS. 9c and d , bar=10 μm.

FIG. 10 is a photograph showing alterations in mitochondrial functioncoincide with abnormal mitochondrial shape following treatment withhydrocortisone. Following 24 hr treatment with 100 μM HC, mitochondriain control fibroblasts visualized with MitoTracker 7510 showed a slightloss in the reticular pattern of the mitochondrial network and greaterfrequency of perinuclear clustering (FIGS. 10b and c , arrows) comparedto untreated cells (FIG. 10a ). Mitochondria from BD subjects labeledwith MitoTracker 7510 and exposed to the same concentration of HC (FIGS.10e and f ) displayed perinuclear clustering (arrows) like that seen inuntreated cells (10 d, arrow) but a greater degree of mitochondrialfragmentation (arrowheads). JC-1 staining of fibroblasts from healthyindividuals treated with HC (FIG. 10g ) revealed loss of redmitochondrial aggregates (arrows) in most cells with an increase in thegreen JC1 monomeric form (arrowheads) compared to untreated cells(compare with FIGS. 9a and c ). JC1 staining of BD fibroblasts treatedwith HC (FIG. 10h ) revealed a loss of red JC1 mitochondrial aggregatesin the majority of cells as well as a qualitative increase in JC1monomeric green fluorescence (arrowheads) than that seen in untreatedfibroblasts from these patients (compare with FIGS. 9a and c ). FIG.10a-h , bar=10 μm.

FIG. 11 is a photograph showing that exposure to H₂O₂ stress exacerbatesmitochondrial dysfunction in fibroblasts from BD patients. Followingexposure with H₂O₂ (FIGS. 11b and c ), control fibroblasts stained withMitotracker 7510 displayed dispersion of the mitochondrial network withloss of elongated mitochondrial profiles, increased perinuclearclustering (arrows), and increased mitochondrial fragmentation(arrowheads) compared to untreated cells (FIG. 11a , arrows).Disturbances in mitochondrial structure and function were enhanced infibroblasts from patients with BD following oxidative stress inducedwith H₂O₂. Fibroblasts from BD patients labeled with MitoTracker 7510(FIG. 11e and f ) showed almost complete loss of the mitochondrialnetwork, mitochondrial clustering and dramatic mitochondrialfragmentation (arrows) compared to untreated cells (arrows). In healthycontrol cells exposed to H₂O₂, the alterations in mitochondrialmorphology were accompanied by loss of mitochondrial permeability,revealed by reduced JC1 red aggregates (arrows) and increased JC1cytosolic monomeric staining (arrowheads) (FIG. 11g , left panel). ATPlevels measured by bioluminescence assay showed no significantdifference in ATP compared to untreated control cells. In fibroblastsfrom patients with BD exposed to H₂O₂, JC1 staining revealed severe lossof mitochondrial membrane integrity that correlated with little to noJC1 red aggregate staining (arrows) and high levels of monomeric JC1(green) in the cytoplasm (arrowheads) (FIG. 11g , middle panel). Themorphologic alterations in mitochondrial membrane potential seen withJC1 staining—a change consistent with collapse of the mitochondrialelectrochemical gradient were accompanied by a 83% decrease in ATPlevels in fibroblasts from BD subjects exposed to H₂O₂ compared tountreated fibroblasts (BD fibroblasts, no treatment—mean=3.8×10⁻⁴, SE5.4×10⁻⁵; BD fibroblasts, H₂O₂ treated—mean=6.2×10⁻⁵, SE 4.2×10⁻⁵,p<0.001) and a 93% decrease compared to control cells exposed to H₂O₂(control fibroblasts, H₂O₂ treated—mean=9.9×10⁻⁴, SE 4.3×10⁻⁴; BDfibroblasts, H₂O₂ treated—mean=6.2×10⁻⁴, SE 4.2×10⁻⁵, p<0.05). FIG.11a-g , bar=10 μm.

DETAILED DESCRIPTION OF THE INVENTION

Applicants have identified methods, kits, and compositions formitochondrial replacement in the treatment of conditions arising from,or accompanied by, mitochondrial dysfunction. Applicants further providemethods for diagnosing neuropsychiatric and neurodegenerative disordersassociated with mitochondrial dysfunction based on mitochondrialstructural abnormalities.

Conditions associated with mitochondrial dysfunction can result in theprogressive mosaic appearance of cells with defective electron transportactivity in muscle, with cells almost devoid of cytochrome c oxidase(COX) activity interspersed randomly amidst cells with normal activity,and a higher incidence of COX-negative cells in biopsies (e.g., in oldersubjects). The organism, during aging, or in a variety of conditionsassociated with mitochondrial dysfunction, is thus faced with asituation in which irreplaceable post-mitotic cells (e.g., neurons,skeletal and cardiac muscle) must be preserved and their functionmaintained to a significant degree, in the face of an inexorableprogressive decline in mitochondrial respiratory chain function. Neuronswith dysfunctional mitochondria become progressively more sensitive toinsults like excitotoxic injury. Mitochondrial failure contributes tomost degenerative diseases (especially neurodegeneration) that accompanyaging. Congenital mitochondrial diseases often involve early-onsetneurodegeneration similar in fundamental mechanism to disorders thatoccur during aging of people born with normal mitochondria. The methods,kits, and compositions of the invention allow for the replacement ofdysfunctional mitochondria in these irreplaceable post-mitotic cells,allowing for the rescue or improvement of the mitochondrial function inthese cells.

Mitochondria are involved in a strikingly diverse range of diseaseprocesses. Primary genetic disorders fall into two broad classes: thosewith deficiencies in either nuclear or mitochondrial genes (see Sholte,J. Bioenerg. Biomembr. 20:161 (1988), reporting over 60 human diseaseswith defects in nuclear genes encoding mitochondrial functions).Mitochondrial dysfunction is also recognized as a contributor to commondiseases with multi-factorial pathogenesis. Some examples are givenbelow, concluding with the condition of aging, which has a clearrelationship to oxidative stress of mitochondrial origin.

Conditions Associated with Mitochondrial Dysfunction

Conditions associated with mitochondrial dysfunction include those inwhich deficits in mitochondrial respiratory chain activity contribute tothe development of pathophysiology of such diseases or disorders in amammal. This includes (1) congenital genetic deficiencies in theactivity of one or more components of the mitochondrial respiratory orelectron transport chain; and (2) acquired deficiencies in the levels oractivities of one or more components of the mitochondrial respiratorychain, wherein such deficiencies are caused by (a) oxidative damageduring aging; (b) elevated intracellular calcium; (c) exposure ofaffected cells to nitric oxide; (d) hypoxia or ischemia; (e)microtubule-associated deficits in axonal transport of mitochondria, or(f) expression of mitochondrial uncoupling proteins.

Common symptoms of mitochondrial dysfunction include cardiomyopathy,muscle weakness and atrophy, developmental delays (involving motor,language, cognitive or executive function), ataxia, epilepsy, renaltubular acidosis, peripheral neuropathy, optic neuropathy, autonomicneuropathy, neurogenic bowel dysfunction, sensorineural deafness,neurogenic bladder dysfunction, dilating cardiomyopathy, migraine,hepatic failure, lactic acidemia, and diabetes mellitus.

Neuropsychiatric Disorders

The brain requires ten fold the energy on average of the rest of thebody. Many neuropsychiatric disorders may be associated withabnormalities of energy production or mitochondrial dysfunction, inparticular. Neuropsychiatric disorders include, without limitationbipolar disorder (BD), schizophrenia, depression, anxiety disorders,attention deficit disorders, addictive disorders, personality disorders,autism and Asperger's disease. The methods, kits, and compositions ofthe invention can be used for the treatment of neuropsychiatricdisorders.

Neurodegenerative Disorders

The methods, kits, and compositions of the invention can be used for thetreatment of neurodegenerative disorders. Many progressive neurologicaldiseases result from the execution of neurons by mitochondrialapoptosis. Friedrich's ataxia results from a genetic defect in thefrataxin gene, which is involved in mitochondrial iron transport(Babcock et al., Science 276:1709 (1997)); human deafness dystoniaresults from a defect in a small component of the mitochondrial proteinimport machinery (Koehler et al., Proc. Natl. Acad. Sci. USA 96:2141(1999)); one well-characterized cause of amyotrophic lateral sclerosisis deficiency in Cu—Zn superoxide dismutase, which is located in themitochondrial intermembrane space as well as the cytoplasm (Deng et al.,Science 261:1047 (1993)). The discovery that several environmentaltoxins cause Parkinsonism by inhibiting respiratory complex I andpromoting the generation of reactive oxygen species has made thiscomplex a focus for research on the basis of Parkinson's disease (Dawsonet al., Science 302:819 (2003)). More recently, the mitochondrialprotein encoded by PINK 1 has provided a direct link betweenmitochondria and Parkinson's disease (Valente et al., Science 304:1158(2004)). Alzheimer's disease is also linked to mitochondrial toxicitythrough the mitochondrial protein ABAD, a target of amyloid (Lustbaderet al., Science 304:448 (2004)). Huntington's Disease has beenassociated with defects in energy metabolism that appear to bewidespread, affecting both the brain and peripheral tissues, and arisingfrom mitochondrial dysfunction (Leegwater-Kim et al., NeuroRx 1:128(2004)). A basic abnormality involved in the pathogenesis of bipolardisorder (BD) is believed to involve energy production and inparticular, mitochondrial activity. Evidence from many sources,including, postmortem, genetic, brain imaging and peripheral cellstudies support energy deficits and mitochondrial dysfunction as oneimportant causative factor in the development of BD (see Hough et al.,Bipolar Disord. 2:145 (2000), Fattal et al., Psychosomatics 47:1 (2006),and Kato et al., Bipolar Disord. 2:180 (2000)).

Diabetes and Metabolic Disease

The methods, kits, and compositions of the invention can be used for thetreatment of diabetes and metabolic disease. The central role ofmitochondria in metabolism of carbohydrates and fatty acids gives thisorganelle an important function in diabetes (Maechler et al., Nature414:807 (2001)). A mouse knockout of an abundant mitochondrialtranscription factor has provided a model for 13-cell ablation injuvenile diabetes (Silva et al., Nat. Genet. 26:335 (2000)). Mutationsin mtDNA and in PPARγ, a master regulator of mitochondrial biogenesis,are correlated with type II diabetes. Insulin release depends onmitochondrial function as influenced by the expression of the membranetransporter UCP2 (Petersen et al., Science 300:1140 (2003); Zhang etal., Cell 105:745 (2001)). The activity of thiazolidinediones asantidiabetic agents appears to depend on their ability to serve asligands for PPARγ and its co-activator, PGC-1, in their control ofexpression of nuclear genes for mitochondrial gene products (Mootha etal., Nature Genet 34:267 (2003); Puigserver et al., Endocr. Rev. 24:78(2003)).

Mitochondrial Toxicity of Therapeutic Agents

The methods, kits, and compositions of the invention can be used for thetreatment of toxicity associated with therapeutic agents. The past fewdecades have witnessed significant progress in development ofchemotherapeutic agents for cancer and viral diseases. In the case ofconventional cancer chemotherapy, the goal of selectively killing tumorcells has been difficult to attain due to collateral toxicity to normalcells. Cancer chemotherapeutic agents delivered to damage nuclear DNAalso directly damage mtDNA as well, even in “resting tissues” wherenuclear DNA replication is inactive, but mtDNA replication continues.Mitochondria are poorly equipped to repair this sort of collateraldamage (Bhatia et al., Nature Reviews Cancer 2:124 (2002)). Nucleosideanalogues used as either anticancer or antiviral agents can also havesignificant mitochondrial toxicity. The best known examples include theinhibition of DNA polymerase y by AZT and dideoxynucleosides used totarget the related HIV reverse transcriptase and the fatalhepatotoxicity of fialuridine observed when this agent was tested foractivity against hepatitis B virus (Lewis et al., Nat. Med. 1:417(1995)). In addition, the myopathy and rhabdomyolysis associated withthe popular cholesterol-lowering statins (Thompson et al., JAMA 289:1681(2003)) are believed to involve interference with mitochondrialubiquinone biosynthesis. Accordingly, the mitochondrial replacementmethods, kits, and compositions of the invention can be used toameliorate the toxicity of drugs. Pharmaceutical agents associated withmitochondrial toxicity include reverse transcriptase inhibitors (e.g.,azidothymidine (AZT), stavudine (D4T), zalcitabine (ddC), didanosine(DDI), fluoroiodoarauracil (FIAU), lamivudine (3TC), and abacavir),protease inhibitors (e.g., ritonavir, indinavir, saquinavir,nelfinavir), and inhibitors of dihydroorotate dehydrogenase DHOD (e.g.,leflunomide, and brequinar), among others.

Migraine

The methods, kits, and compositions of the invention can be used for thetreatment of migraine. Metabolic studies on patients with recurrentmigraine headaches indicate that deficits in mitochondrial activity arecommonly associated with this disorder, manifesting asimpaired-oxidative phosphorylation and excess lactate production. Suchdeficits are not necessarily due to genetic defects in mitochondrialDNA. Migrainers are hypersensitive to nitric oxide, an endogenousinhibitor of cytochrome c oxidase. In addition, patients withmitochondrial cytopathies, e.g., MELAS, often have recurrent migraines.

Ocular Disorders Associated with Mitochondrial Dysfunction

The methods, kits, and compositions of the invention can be used for thetreatment of ocular disorders, such as glaucoma, diabetic retinopathyand age-related macular degeneration. Retinal damage is attributed tofree radical initiated reactions in glaucoma, diabetic retinopathy andage-related macular degeneration (AMD). The eye is a part of the centralnervous system and has limited regenerative capability. The retina iscomposed of numerous nerve cells which contain the highest concentrationof polyunsaturated fatty acids (PFA) and subject to oxidation. Freeradicals are generated by UV light entering the eye and mitochondria inthe rods and cones, which generate the energy necessary to transformlight into visual impulses. Free radicals cause peroxidation of the PFAby hydroxyl or superoxide radicals which in turn propagate additionalfree radicals. The free radicals cause temporary or permanent damage toretinal tissue.

Glaucoma is usually viewed as a disorder that causes an elevatedintraocular pressure (IOP) that results in permanent damage to theretinal nerve fibers, but a sixth of all glaucoma cases do not developan elevated IOP. This disorder is now perceived as one of reducedvascular perfusion and an increase in neurotoxic factors. Recent studieshave implicated elevated levels of glutamate, nitric oxide andperoxynitirite in the eye as the causes of the death of retinal ganglioncells.

Diabetic retinopathy occurs when the underlying blood vessels developmicrovascular abnormalities consisting primarily of microaneurysms andintraretinal hemorrhages. Oxidative metabolites are directly involvedwith the pathogenesis of diabetic retinopathy and free radicals augmentthe generation of growth factors that lead to enhanced proliferativeactivity. Nitric oxide produced by endothelial cells of the vessels mayalso cause smooth muscle cells to relax and result in vasodilation ofsegments of the vessel. Ischemia and hypoxia of the retina occur afterthickening of the arterial basement membrane, endothelial proliferationand loss of pericytes. The inadequate oxygenation causes capillaryobliteration or nonperfusion, arteriolar-venular shunts, sluggish bloodflow and an impaired ability of RBCs to release oxygen. Lipidperoxidation of the retinal tissues also occurs as a result of freeradical damage.

Ischemia Related Conditions

The methods, kits, and compositions of the invention can be used for thetreatment of ischemia related conditions. Oxygen deficiency results inboth direct inhibition of mitochondrial respiratory chain activity bydepriving cells of a terminal electron acceptor for cytochrome creoxidation at Complex IV, and indirectly, especially in the nervoussystem, via secondary post-anoxic excitotoxicity and nitric oxideformation. In conditions like cerebral anoxia, angina or sickle cellanemia crises, tissues are relatively hypoxic. In such cases, anincrease in mitochondrial activity provides protection of affectedtissues from deleterious effects of hypoxia, attenuate secondary delayedcell death, and accelerate recovery from hypoxic tissue stress andinjury. The methods, kits, and compositions of the invention can beuseful for preventing delayed cell death (apoptosis in regions like thehippocampus or cortex occurring about 2 to 5 days after an episode ofcerebral ischemia) after ischemic or hypoxic insult, for example, to thebrain.

Muscle Function

The methods, kits, and compositions of the invention can be used forenhancing muscle performance. For example, the methods, kits, andcompositions of the invention may be useful for improving physicalendurance (e.g., ability to perform a physical task such as exercise,physical labor, sports activities, etc.), inhibiting or retardingphysical fatigues, enhancing blood oxygen levels, enhancing energy inhealthy individuals, enhance working capacity and endurance, reducingmuscle fatigue, reducing stress, enhancing cardiac and cardiovascularfunction, improving sexual ability, increasing muscle ATP levels, and/orreducing lactic acid in blood.

Enhanced sports performance, strength, speed and endurance are typicallymeasured by an increase in muscular contraction strength, increase inamplitude of muscle contraction, shortening of muscle reaction timebetween stimulation and contraction, the ability to overcome musclefatigue, and ability to maintain activity for longer periods of time.Aside from muscle performance during endurance exercise, free radicalsand oxidative stress parameters are affected in pathophysiologicalstates. A substantial body of data now suggests that oxidative stresscontributes to muscle wasting or atrophy in pathophysiological states(see Clarkson, Crit. Rev. Food Sci. Nutr. 35:31 (1995); and Powers etal., Proc. Nutr. Soc. 58:1025 (1999)). For example, in musculardystrophies dystrophin-glycoprotein complex (DGC) defects suggest thatone mechanism of cellular injury is functional ischemia related toalterations in cellular NOS and disruption of a normal protective actionof NO. Rando (Microsc. Res. Tech. 55:223 (2001)) has shown thatoxidative injury precedes pathologic changes and that muscle cells withdefects in the DGC have an increased susceptibility to oxidantchallenges. Excessive lipid peroxidation due to free radicals has alsobeen shown to be a factor in myopathic diseases such as McArdle'sdisease (see Russo et al., Med. Hypotheses. 39:147 (1992)). Furthermore,mitochondrial dysfunction is a well-known correlate of age-relatedmuscle wasting (sarcopenia) and free radical damage has been suggested,though poorly investigated, as a contributing factor (see Navarro etal., Front. Biosci. 6:D26 (2001)). Other indications include acutesarcopenia, for example muscle atrophy and/or cachexia associated withburns, bed rest, limb immobilization, or major thoracic, abdominal,and/or orthopedic surgery. The methods of the present invention can beeffective in the treatment of muscle related pathological conditions.

Aging

The methods, kits, and compositions of the invention can be used for thetreatment of aging and conditions associated therewith. During normalaging, there is a progressive decline in mitochondrial respiratory chainfunction. Beginning about age 40, there is an exponential rise inaccumulation of mitochondrial DNA defects in humans, and a concurrentdecline in nuclear-regulated elements of mitochondrial respiratoryactivity. Many mitochondrial DNA lesions have a selection advantageduring mitochondrial turnover, especially in post-mitotic cells. Theproposed mechanism is that mitochondria with a defective respiratorychain produce less oxidative damage to themselves than do mitochondriawith intact functional respiratory chains (mitochondrial respiration isthe primary source of free radicals in the body). Therefore,normally-functioning mitochondria accumulate oxidative damage tomembrane lipids more rapidly than do defective mitochondria, and are,therefore, “tagged” for degradation by the autophagic and lysosomalsystems. Since mitochondria within cells have a half life of about 10days, a selection advantage can result in rapid replacement offunctional mitochondria with those with diminished respiratory activity,especially in slowly dividing cells. The net result is that once amutation in a gene for a mitochondrial protein that reduces oxidativedamage to mitochondria occurs, such defective mitochondria will rapidlypopulate the cell, diminishing or eliminating its respiratorycapabilities. The inexorable decline of mitochondrial function with agecontributes to the aging-related conditions of neurodegeneration, andtype II diabetes. Just as oxidative stress underlies some of thesedefined diseases, it is thought to contribute to generalized aging(Harman, Proc. Natl. Acad. Sci. USA 78:7124 (1981)). Mutations in C.elegans and D. melanogaster that reduce mitochondrial oxidative stresshave been shown to prolong lifespan in these organisms (Hekimi et al.,Science 299:1351 (2003)). Moreover, mammals maintained oncalorie-restricted diets have a reduced metabolic rate that is thoughtto contribute to significantly increased longevity. Numerous studieshave documented an increase in point mutations and deletions in mtDNAwith advancing age. Furthermore, Trifunovic et al. have recently showedthat mice engineered to express an error prone mitochondrial DNApolymerase can serve as an excellent model for premature ageing (Nature429:417 (2004)).

Isolation of Mitochondria

The key steps when isolating mitochondria from any tissue or cell aretypically: (i) rupturing of cells by mechanical and/or chemical means,(ii) differential centrifugation at low speed to remove debris andextremely large cellular organelles, and (iii) centrifugation at ahigher speed to isolate and collect and substantially pure mitochondria.Suggested amounts of starting material and expected mitochondria yieldsare shown in Table 1 for rodent tissues.

TABLE 1 Starting Material Expected Sample (wet weight) Yield Rodentliver 0.3-0.5 g 2-4 mg Rodent heart* 0.2-0.4 g 1-2 mg Rodent brain0.3-0.4 g 4-5 mg *Hard tissues result in lower yields due to difficulthomogenization.

Buffers and samples should be chilled where possible.

Mitochondria integrity can be tested by screening for cytochrome c,porin, or cyclophilin D in the isolated mitochondria versus in thesupernatant fraction (i.e., using commercially available antibodykits—see, for example, those available from MitoSciences®). Whileisolated mitochondria for use in the methods, kits, and compositions ofthe invention can be obtained from any allogeneic, syngeneic, orxenogeneic source, it is often desirable to extract the mitochondria foruse in the methods, kits, and compositions of the invention fromprogenitor cells.

Progenitor Cells

Desirably, the cells from which mitochondria are isolated for use in themethods, kits, and compositions of the invention are undifferentiatedmarrow-derived adult progenitor cells (MAPCs). The isolation of MAPCs iswell known in the art (see, for example, Gartner et al., Proc. Nat.Acad. Sci. USA 77:4756 (1980); Mauney et al., Tissue Engin. 10:81(2004); Sutherland et al., Proc. Nat. Acad. Sci. USA 87:3584 (1990);Ramshaw et al., Exp. Hematol. 29:981 (2001); Kassem, Ann. NY Acad. Sci.1067:436 (2006); Sotiropoulou et al., Stem Cells 24:1409 (2006); Romanovet al., Bull Exp. Biol. Med. 140:138 (2005); Alhadlaq et al., Stem CellDev. 13:436 (2004); Hung et al., Stem Cells 20:249 (2002); Tondeau etal., Cytotherapy 6:372 (2004); Smith et al., Stem Cells 22:823 (2004);Baxter et al., Stem Cells 22:675 (2004); Jones et al., Arthritis Rheum.46:3349 (2002); and Prockop et al., Cytotherapy 3:393 (2001)).

Alternatively, the cells from which mitochondria are isolated can beselected from neural stem cells, muscle stem cells, satellite cells,liver stem cells, hematopoietic stem cells, bone marrow stromal cells,epidermal stem cells, embryonic stem cells, mesenchymal stem cells,umbilical cord stem cells, precursor cells, muscle precursor cells,myoblast, cardiomyoblast, neural precursor cells, glial precursor cells,neuronal precursor cells, hepatoblasts, neurons, oligodendrocytes,astrocytes, Schwann cells, skeletal muscle cells, cardiomyocytes, orhepatocytes. Immortalized cells can also be used as a) source.

The source of cells for mitochondrial isolation can be the patient to betreated him or herself, a relative, an unrelated donor or a donor ofanother species. Once isolated, mitochondria can be cultured, and thesecultured mitochondria can also be used in the mitochondrial replacementtherapy described herein.

Mitochondrial Replacement Therapy Formulation

The pharmaceutical compositions and kits of the invention may containpharmaceutically acceptable excipients for modifying, maintaining, orpreserving, for example, the pH, osmolarity, viscosity, clarity, color,isotonicity, odor, sterility, stability, rate of dissolution or release,adsorption, or penetration of the composition. Suitable formulationmaterials include, but are not limited to, amino acids (such as glycine,glutamine, asparagine, arginine, or lysine), antimicrobials,antioxidants (such as ascorbic acid, sodium sulfite, or sodiumhydrogen-sulfite), buffers (such as borate, bicarbonate, Tris-HCl,citrates, phosphates, or other organic acids), bulking agents (such asmannitol or glycine), See Remington's Pharmaceutical Sciences (18th Ed.,A. R. Gennaro, ed., Mack Publishing Company 1990).

For example, lipids may be used in the present invention as a carrier inthe formulation of isolated and purified mitochondria of the invention.The lipids may be natural, synthetic or semisynthetic (i.e., modifiednatural). Lipids useful in formulating the compositions of theinvention, without limitation, fatty acids, lysolipids, oils (includingsafflower, soybean and peanut oil), phosphatidylcholine with bothsaturated and unsaturated lipids, including phosphatidylcholine;dioleoylphosphatidylcholine; dimyristoylphosphatidylcholine;dipentadecanoylphosphatidylcholine, dilauroylphosphatidylcholine,dioleoylphosphatidylcholine, dipalmitoylphosphatidylcholine; anddistearoylphosphatidylcholine; phosphatidylethanolamines, such asdioleoylphosphatidylethanolamine; phosphatidylserine;phosphatidylglycerol; phosphatidylinositol, sphingolipids, such assphingomyelin; glycolipids, such as ganglioside GM1 and GM2;glucolipids; sulfatides; glycosphingolipids; phosphatidic acid; palmiticacid; stearic acid; arachidonic acid; oleic acid; lipids bearingpolymers such as polyethyleneglycol, chitin, hyaluronic acid orpolyvinylpyrrolidone; lipids bearing sulfonated mono-, di-, oligo- orpolysaccharides; cholesterol, cholesterol sulfate and cholesterolhemisuccinate; tocopherol hemisuccinate, lipids with ether andester-linked fatty acids, polymerized lipids (a wide variety of whichare known in the art), diacetyl phosphate, stearylamine, cardiolipin,phospholipids with short chain fatty acids of about 6 to about 8 carbonsin length, synthetic phospholipids with asymmetric acyl chains (e.g.,with one acyl chain of about 6 carbons and another acyl chain of about12 carbons), 6-(5-cholesten-3b-yloxy)-1-thio-β-D-galactopyranoside,digalactosyldiglyceride,6-(5-cholesten-3.beta.-yloxy)hexyl-6-amino-6-deoxy-1-thio-β-D-galactopyranoside,6-(5-cholesten-3.beta.-yloxy)hexyl-6-amino-6-deoxyl-1-thio-.alpha.-D-mannopyranoside,12-(((7′-diethylamino-coumarin-3-yl)carbonyl)methylamino)-octadecanoicacid;N-[12-(((7′-diethylaminocoumarin-3-yl)carbonyl)methyl-amino)octadecanoyl]-2-aminopalmiticacid; (cholesteryl)4′-trimethyl-ammonio)butanoate;N-succinyldioleoylphosphatidylethanolamine; 1,2-dioleoyl-sn-glycerol;1,2-dipalmitoyl-3-succinyl-glycerol; 1,3-dipalmitoyl-2-succinylglycerol;1-hexadecyl-2-palmitoyl-glycerophosphoethanolamine;palmitoylhomocysteine; and combinations thereof. Vesicles or otherstructures may be formed of the lipids, either as monolayers, bilayers,or multilayers and may or may not have a further coating. Vesicles orother lipid structures used as carriers can further include, e.g.,peptides, polypeptides, glycoproteins, or other constituents useful forthe generation, viability, or targeting of such carriers. For example,vesicles bearing a protein ligand can be used to specifically targetcells that express a cognate receptor to facilitate targeted applicationof the purified mitochondria of the invention.

Cationic lipids and other derivatized lipids and lipid mixtures also maybe useful as carriers for use in the methods, kits, and compositions ofthe invention. Suitable cationic lipids include dimyristyloxypropyl-3-dimethylhydroxy ethylammonium bromide (DMRIE), dilauryloxypropyl-3-dimethylhydroxy ethylammonium bromide (DLRIE),N-[1-(2,3-dioleoyloxyl)propal]-n,n,n-trimethylammonium sulfate (DOTAP),dioleoylphosphatidylethanolamine (DOPE),dipalmitoylethylphosphatidylcholine (DPEPC), dioleoylphosphatidylcholine(DOPC), polylysine, lipopolylysine, didoceyl methylammonium bromide(DDAB),2,3-dioleoyloxy-N-[2-(sperminecarboxamidoethyl]-N,N-di-methyl-1-propanaminium trifluoroacetate (DOSPA), cetyltrimethylammonium bromide (CTAB),lysyl-PE, 3.beta.-[N,(N′,N′-dimethylaminoethane)-carbamoyl]cholesterol(DC-Cholesterol, also known as DC-Chol), (-alanyl cholesterol,N-[1-(2,3-dioleoyloxy)propyl]-N,N,N-trimethylammonium chloride (DOTMA),dipalmitoylphosphatidylethanolamine-5-carboxyspermylamide (DPPES),dicaproylphosphatidylethanolamine (DCPE), 4-dimethylaminopyridine(DMAP), dimyristoylphosphatidylethanolamine (DMPE),dioleoylethylphosphocholine (DOEPC), dioctadecylamidoglycyl spermidine(DOGS),N-[1-(2,3-dioleoyloxy)propyl]-N-[1-(2-hydroxyethyl)]-N,N-dimethylammoniumiodide (DOHME), Lipofectin (DOTMA+DOPE, Life Technologies, Inc.,Gaithersburg, Md.), Lipofectamine (DOSPA+DOPE, Life Technologies, Inc.,Gaithersburg, Md.), Transfectace (Life Technologies, Inc., Gaithersburg,Md.), Transfectam (Promega Ltd., Madison, Wis.), Cytofectin (LifeTechnologies Inc., Gaithersburg, Md.). Other representative cationiclipids include but are not limited to phosphatidylethanolamine,phospatidylcholine, glycero-3-ethylphosphatidylcholine and fatty acylesters thereof, di- and trimethyl ammonium propane, di- andtri-ethylammonium propane and fatty acyl esters thereof. A preferredderivative from this group isN-[1-(2,3-dioleoyloxy)propyl]-N,N,N-trimethylammonium chloride (DOTMA).Additionally, a wide array of synthetic cationic lipids function ascompounds useful in the invention. These include common natural lipidsderivatized to contain one or more basic functional groups. Examples oflipids which may be so modified include but are not limited todimethyldioctadecylammonium bromide, sphingolipids, sphingomyelin,lysolipids, glycolipids such as ganglioside GMI, sulfatides,glycosphingolipids, cholesterol and cholesterol esters and salts,N-succinyldioleoylphosphatidylethanolamine, 1,2-dioleoyl-sn-glycerol,1,3-dipalmitoyl-2-succinylglycerol,1,2-dipalmitoyl-sn-3-succinylglycerol,1-hexadecyl-2-palmitoylglycerophosphatidyl-ethanolamine andpalmitoylhomocystiene.

The methods, kits, and compositions of the invention can include theformulation of mitochondria with one or more agents (e.g., vitamins,antioxidants, acetyl-L-carnitine, alpha-lipoic acid, cardiolipin, fattyacids, lithium carbonate, lithium citrate, calcium, ors-adenosyl-L-methionine) or mixtures thereof, such as those describedherein.

The mitochondria for use in the methods, compositions, and kits of theinvention can be packaged in unit dosage forms, for example in vials,ampoules, pre-filled syringes, or sachets.

Administration

The formulations can be administered to human subjects intherapeutically effective amounts. Typical dose ranges are from about 1mg/kg to about 10 g/kg of body weight. The preferred dosage of isolatedand substantially pure mitochondria to be administered is likely todepend on such variables as the type and extent of the disorder, theoverall health status of the particular subject, the specific compoundbeing administered, the excipients used to formulate the mitochondria,and its route of administration. Standard clinical trials maybe used tooptimize the dose and dosing frequency for any condition and route ofadministration.

For systemic administration, isolated and substantially puremitochondria can be, without limitation, administered by intranasal,intravenous, intra-arterial, subcutaneous, or intramuscular routes. Themitochondria can be administered alone (e.g., as a monotherapy),subsequent to pretreatment with one of several second agents describedherein, or in combination with one of several second agents describedherein (e.g., either formulated together and administeredsimultaneously, or formulated separately and administered within 2 hoursof each other).

For the treatment of conditions associated with localized mitochondrialdysfunction (e.g., ocular disorders, neurodegenerative disorders,neuropsychiatric disorders, and other localized tissues) it may bedesirable to administer the isolated and substantially pure mitochondrialocally. Local routes of administration include, without limitation,local injection, intracranial, intracerebroventricular, intracerebral,intraorbital, ophthalmic, intraventricular, intracapsular, intraspinal,intrathecal, intracisternal, intraperitoneal, intranasal, or topicaladministration. For example, the isolated and substantially puremitochondria can be administered directly into discrete areas or nucleiof the brain, e.g., the rostral ventromedial medulla (RVM) or a brainventricle, or onto the dura mater.

Combination Therapy

Isolated and substantially pure mitochondria can be used in combinationwith a second agent selected from vitamins (e.g., vitamin A, vitamin C,vitamin D, vitamin E, vitamin K, folic acid, choline, vitamin B₁,vitamin B₂, vitamin B₅, vitamin B₆, and vitamin B₁₂, biotin,nicotinamide), antioxidants (e.g., betacarotene, coenzyme Q, selenium,superoxide dismutase, glutathione peroxide, uridine, catalase, creatinesuccinate, pyruvate, dihydroxyacetone), acetyl-L-carnitine, alpha-lipoicacid, cardiolipin, fatty acids (e.g., omega-3 fatty acids or omega-6fatty acids), lithium carbonate, lithium citrate, calcium, ands-adenosyl-L-methionine. These additional agents can be directlyadministered to the patient (e.g., orally or intravenously) andformulated together with the isolated and substantially puremitochondria or formulated and administered separately.

Abnormalities in Mitochondrial Structure

Neurons and glia in the prefrontal cortices of postmortem brain frompatients with BD display abnormalities in mitochondrial morphology andintracellular distribution. These alterations are also exhibited inprimary skin fibroblasts and lymphocytes obtained from living patients.Under basal metabolic conditions, these structural abnormalities existin the absence of detectable changes in ATP levels or loss ofmitochondrial membrane potential. However, metabolic stress, promoted bytreatment with hydrocortisone or hydrogen peroxide, resulted indecreased ATP levels and loss of mitochondrial membrane potential thatwas greater in cells from patients with BD than healthy controls. Also,these treatments caused alterations in mitochondrial structure anddistribution in control cells resembling those seen in untreated cellsfrom individuals with BD. Our results are consistent with evidencelinking reduced energy production and mitochondrial dysfunction to BD.Whether (1) alterations in mitochondrial shape and distribution are theunderlying cause of energy dysfunction in BD, (2) structuralabnormalities of mitochondria are secondary to mitochondrial dysfunctionand impaired energy metabolism evoked by neuroendocrine, oxidative, orpossibly other stresses, or (3) both altered mitochondrial structure andfunction are epiphenomena associated with an independent dysfunction ofspecific cell types in BD is unknown. Regardless, the mitochondrialabnormalities identified here have broad implications for cellplasticity, resilience, and survival in patients with BD, and can beused as a pathognomic marker for bipolar disorder and otherneuropsychiatric and neurodegenerative disorders associated withmitochondrial dysfunction.

Our findings are consistent across three different tissues—brain,fibroblasts and lymphocytes—from two different tissue collections. Thestructural abnormalities observed were only seen in the tissues fromdiseased individuals (e.g., individuals with BD) and were associatedwith a functional difference consistent with those observed in previousbrain imaging and tissue studies in patients. Not all of the subjectswere receiving the same medications, and the abnormality could not bereplicated by exposure of cells in vitro to the medication the subjectsmost commonly received (i.e., lithium). This suggests, that the effectis a concomitant of illness rather than a consequence of treatment.

Both in postmortem brain and primary fibroblasts and lymphocytes fromliving individuals with BD, striking morphologic abnormalities ofmitochondria were observed. Similar alterations in mitochondrialstructure and arrangement have been associated with an imbalance inmitochondrial fission and fusion events, which are concomitants of awide range of cellular functions including energy metabolism(Escobar-Henriques et al., Biochim. Biophys. ACTA 1763:422-429 (2006),Logan et al., J. Exp. Bot. 57:1225-1243 (2006), McBride et al., Curr.Biol. 16:R551-R560 (2006), and Mannella, Biochim. Biophys. ACTA1762:140-147 (2006)).

As a high user of energy, the brain may be particularly disadvantaged byany dysfunction of mitochondria. Considerable evidence suggests thatmitochondrial fission and fusion events may be involved in maintainingmitochondrial transport and delivery to cellular sites requiring highenergy demands (Chan, Cell 125:1241-1252 (2006), Logan et al., J. Exp.Bot. 57:1225-1243 (2006), McBride et al., Curr. Biol. 16:R551-R560(2006), Mannella, Biochim. Biophys. ACTA 1762:140-147 (2006),Bossy-Wetzel et al., Curr. Opin. Cell Biol. 15:706-716 (2003), and Zannaet al., Brain 131:352-367 (2008)), which in neurons and supporting gliais particularly important and, if impaired, could lead to cellularcompromise or degeneration (Chan, Cell 125:1241-1252 (2006), Logan etal., J. Exp. Bot. 57:1225-1243 (2006), McBride et al., Curr. Biol.16:R551-R560 (2006), and Mannella, Biochim. Biophys. ACTA 1762:140-147(2006), and Bossy-Wetzel et al., Curr. Opin. Cell Biol. 15:706-716(2003)). Permeability changes in the outer mitochondrial membrane evokedby cortisol or oxidative damage leading to collapse of membranepotential, release of cytochrome C and other apoptotic mitochrondrialproteins and caspase activation have been shown to initiate apoptoticcell death (Beal, Free Rad. Biol. 32:797-803 (2002), Chan, Cell125:1241-1252 (2006), Frederick et al., J. Cell Biol. 167:87-98 (2004),Bossy-Wetzel et al., Curr. Opin. Cell Biol. 15:706-716 (2003), andKoopman et al., Am. J. Physiol. Cell Physiol. 288:C1440-C1450 (2005)).While we did not see evidence of apoptosis in peripheral cells, suchevents could occur during brain development. Therefore, it is possiblethat abnormal mitochondrial function underlies cellular abnormalitiessuch as the reduced glial density consistently observed in BD subjectsin several post mortem studies of prefrontal cortex, a highly energydependent region of brain.

Bipolar disorder is most often recurrent and episodes are most likely tooccur during periods of stress, with attendant hormonal responses.Changes in mitochondrial bioenergetics have been linked to metabolicstress (Chan, Cell 125:1241-1252 (2006), Rossignol et al., Cancer Res.64:985-993 (2004), Escobar-Henriques et al., Biochim. Biophys. ACTA1763:422-429 (2006), Logan et al., J. Exp. Bot. 57:1225-1243 (2006),McBride et al., Curr. Biol. 16:R551-R560 (2006), Koopman et al., Am. J.Physiol. Cell Physiol. 288:C1440-C1450 (2005), Naydenov et al., Arch.Gen. Psychiatr. 64:555-564 (2007), and Kato et al., Bipolar Disord.2:180-190 (2000)). Our results show that mitochondrial stress induced byhydrocortisone or oxidative damage using H₂O₂ can induce morphologicfeatures, i.e., mitochondrial aggregation, in control cells resembling,at least in part, those seen in untreated cells from patients with BD.In cells from healthy individuals, these changes in mitochondrialmorphology were not accompanied by detectable alterations inmitochondrial function (i.e., reduced ATP levels or loss ofmitochondrial membrane potential) suggesting that the degree of stressinduced dysfunction is not sufficient to disrupt energy metabolism.However, fibroblasts from individuals with BD, which are accompanied byalterations in mitochondrial shape and distribution under basalconditions, when treated with hydrocortisone or H₂O₂, exhibit animpaired mitochondrial stress response characterized by reduced levelsof ATP and loss of membrane potential. These dysfunctions in energymetabolism may be factors which precipitate alterations in mitochondrialshape and arrangement. Alternatively, structurally abnormal mitochondriamay be unable to adapt to conditions of increased energy demand whencells are stressed.

Cumulatively, our findings show that changes in mitochondrial shape anddistribution are a consistent feature of neurons and primarynon-neuronal cells from individuals with BD. These changes are not seenin tissue from healthy control subjects under basal conditions.Prominent functional alterations of mitochondria were not observed incells from BD subjects. Thus, structural abnormalities preceded evidenceof abnormal mitochondrial function. Mitochondrial stress induced withhydrocortisone or H₂O₂ induced BD-like mitochondrial changes inmorphology in control cells. In cells from patients with BD exposure tosuch stressors was accompanied by reduced ATP levels and loss inmitochondrial membrane potential. Our findings suggest that themitochondrial changes in cells from patients with BD representmorphological antecedents to functional changes which are evoked withcell stress when neuroprotective mechanisms are impaired, resulting inabnormal energy metabolism. These findings also support the possibilitythat alterations in mitochondrial structure and function may play a rolein neuronal and or glial compromise or cell loss in BD.

EXAMPLES

The following examples are put forth so as to provide those of ordinaryskill in the art with a complete disclosure and description of how themethods and compounds claimed herein are performed, made, and evaluated,and are intended to be purely exemplary of the invention and are notintended to limit the scope of what the inventors regard as theirinvention.

Example 1 Mitochondrial Replacement Therapy Mitochondrial Preparationand Structural/Functional Analyses

Mitochondrial isolates can be generated from normal skin fibroblastsusing gradient centrifugation (Choi et al., Ann NY Acad Sci 1042:88(2005)). Because metabolic enzyme activities are thought to be differentin neuronal and astrocytic mitochondria, undifferentiated marrow-derivedadult progenitor cells (MAPCs), which can transdifferentiate intoneurons or glia, can be used as a source of mitochondria. We havegenerated pure preparations of actively respiring mitochondria from bothcell types in preliminary studies. Purity and morphologicalcharacteristics of the isolates can be determined by electronmicroscopy. Functional respiratory integrity (proton cycling, oxygenconsumption) can be evaluated with specific fluorescent probes,polarimetrically by oxygen electrode, and by cytochrome C oxidaseactivity. Mitochondrial electron transport chain complexes I-III and ATPsynthase (complex V) can be quantified by Western blotting. ATP can bemeasured by luciferin-luciferase assay. Evidence of apoptosis can beprovided by light and electron microscopic examination using standardtechniques. Mitochondrial isolates from healthy cells can be deliveredby e.g., lipid micelles, to the cultured cell and animal modelsdescribed below. Cell and animal models receiving vehicle-containingmicelles can be used as additional controls.

Formulation

Mitochondrial isolates from healthy cells can be delivered by e.g.,lipid micelles, lipid rafts, or clathrin-coated vesicles. Isolates willbe obtained from fresh normal healthy cell types and purified byestablished gradient centrifugation (see above). Purity of mitochondrialisolates and mitochondrial activity will be confirmed as describedabove. Donor isolates will be packaged using standard transfectionprotocol in inert, lipid micelles (Lipofectamine 2000® or equivalent)and will be stored no longer than 5 days at 4° C.

The mitochondria can be stored or administered with one of several“cocktails” depending upon the specific deficit to be addressed in thecondition to be treated. These cocktails can include vitamins (e.g.,vitamin A, vitamin C, vitamin D, vitamin E, vitamin K, folic acid,choline, vitamin B₁, vitamin B₂, vitamin B₅, vitamin B₆, and vitaminB₁₂, biotin, nicotinamide), antioxidants (e.g., betacarotene, coenzymeQ, selenium, superoxide dismutase, glutathione peroxide, uridine,catalase, creatine succinate, pyruvate, dihydroxyacetone),acetyl-L-carnitine, alpha-lipoic acid, cardiolipin, fatty acids (e.g.,omega-3 fatty acids or omega-6 fatty acids), lithium carbonate, lithiumcitrate, calcium, and s-adenosyl-L-methionine. Cocktails useful in themethods, kits, and compositions of the invention are provided in Table2.

TABLE 2 mixture Components¹ Mix 1 biotin, acetyl-L-carnitine,alpha-lipoic acid, calcium Mix 2 acetyl-L-carnitine, alpha-lipoic acid,vitamins Mix 3 acetyl-L-carnitine, alpha-lipoic acid, antioxidants Mix 4acetyl-L-carnitine, alpha-lipoic acid, vitamins, cardiolipin Mix 5acetyl-L-carnitine, alpha-lipoic acid, vitamins, cardiolipin,antioxidants Mix 6 acetyl-L-carnitine, alpha-lipoic acid, antioxidants,biotin Mix 7 biotin, acetyl-L-carnitine, alpha-lipoic acid, calcium,choline, cardiolipin Mix 8 biotin, acetyl-L-carnitine, alpha-lipoicacid, calcium, choline, cardiolipin, vitamins Mix 9 biotin,acetyl-L-carnitine, alpha-lipoic acid, calcium, choline, cardiolipin,antioxidants Mix 10 All components of mixtures 1-9 Mix 11 omega 3 and 6fatty acids, vitamins Mix 12 omega3 and 6 fatty acids, antioxidants Mix13 biotin, acetyl-L-carnitine, alpha-lipoic acid, calcium, omega3 and 6fatty acids, cardiolipin, choline ¹Where the table refers generically to“antioxidant” or “vitamin” the antioxidant or vitamin can be selectedfrom any described herein, respectively.

Cell Culture Models A. Normal Fibroblasts Exposed to MitochondrialToxins

To inhibit complex I mitochondrial enzymes, normal human skinfibroblasts can be grown under standard conditions and treated withincreasing concentrations of rotenone. To inhibit all mtDNA encodedmitochondrial enzymes of the electron transport chain (ETC), cells canbe exposed to ethidium bromide (Li et al., J Biol. Chem. 278:8516(2003); Miller et al., J Neurochem. 67:1897 (1996); and Panov et al., JBiol. Chem. 280:42026 (2005)). Following treatments, cell homogenatesand media as well as purified mitochondria can be collected andevaluated by functional assays as described above. Sister culturestreated in a similar fashion and can be processed for light and electronmicroscopy using the probes mentioned. Fibroblasts grown in the samemedium without rotenone or ethidium bromide can be used throughout ascontrols.

B. Fibroblasts from Patients with BD

Our studies show that fibroblasts from patients with BD exhibitabnormalities in mitochondrial structure (FIG. 2, A vs. B). In addition,we have found that transplantation of healthy mitochondria to BDfibroblasts restores the normal mitochondrial phenotype (FIG. 2, C vsD).

C. MtDNA-Depleted Neuronal Cell Line

A respiratory deficient neuroblastoma cell line can be generated asdescribed by (Chomyn, Methods Enzymol 264:334 (1996); Miller et al., JNeurochem. 67:1897 (1996); King et al., Cell 52:811 (1988); and King etal., Science 246:500 (1989)) by selectively depleting mtDNA throughprolonged exposure to ethidium bromide. Differentiation can be inducedfor 2 to 3 weeks using retinoic acid.

Animal Models

The methods, kits, and compositions of the invention can be used torescue cells having impaired function associated with mitochondrialdysfunction as demonstrated in the bitransgenic mouse and POLGtransgenic mouse models described below.

A. Bitransgenic Mice

Mice expressing a tetracycline-controlled transactivator driven by humanglial fibrillary acidic protein (GFAP) promoter can be mated with asecond transgenic strain which carries a gene(s) of interest under theregulation of the tetracycline-responsive promoter. Expression of thegene of interest in the bitransgenic offspring can be induced inastrocytes by withdrawal of the tetracycline analog, doxycycline,administered in drinking water. Defective oxidative phosphorylation inastrocytes can be induced by expression of genetic variations of complexI enzymes and a targeted mutant of cytochrome C. Non-transgeniclittermates can be used as controls. Following the administration ofstandard behavioral testing, tissue blocks of the frontal lobe,hippocampus, basal ganglia and cerebellum can be harvested formorphological and structural analyses.

B. POLG Transgenic Mice

Transgenic (tg) mice with a neuron-specific defect in the POLG gene,which encodes for nuclear-encoded mtDNA polymerase, can be obtained fromJackson Laboratories. These animals exhibit forebrain specific defectsin mtDNA and behavioral characteristics resembling mood disorders, suchas BD. Mice ranging in age from 17 weeks to 12 months that displayprogressive phenotypic changes (Kasahara et al., Molecular Psychiatry11:577 (2006)) can be examined. Non-tg mice can be used as controls.Because of the synergy between neurons and glia, mutations in POLG thataffect mtDNA replication or ETC enzymes in neurons could potentiallyalter energy-dependent interactions between glia and neurons and therebyalter glial energy metabolism and viability.

Example 2 Diagnoses Based Upon Abnormalities in Mitochondrial StructureMitochondria in Neurons of BD Brain are Abnormal in Shape

We initially sought to determine if changes in mitochondrial morphologyand spatial distribution were present in the prefrontal cortex ofpostmortem brain from patients diagnosed in life with BD. Prefrontalcortex was chosen as it is a documented site of abnormalities in brainstructure and function in patients with BD (Ongur et al., Proc. Natl.Acad. Sci. 95:13290-13295 (1998)). Ultrastructural examination of humanbrain tissue from healthy controls showed, in both neurons and glia,that mitochondrial profiles were distributed randomly throughout thecell soma in close proximity to the nucleus (FIG. 5a ) as well as moreperipherally within processes (data not shown). Most mitochondriaappeared as small rounded structures approximately 0.5 μm in width or asrod-shaped profiles 0.1 μM in diameter and several microns in length.Each organelle was bounded by a smooth outer membrane and hadinvaginated inner cristae. Branching was not uncommon and, frequently,small mitochondria profiles were seen interspersed with several largerprofiles (FIG. 5a,b ).

In sections of brains from patients with BD, the distribution andmorphology of mitochondria were dramatically different. In the cellbody, mitochondrial profiles aggregated in the perinuclear region (FIG.5c,d ) and the extent of the clustering varied from cell to cell.Mitochondrial profiles varied in size but, compared to those fromhealthy brain, most profiles were longer and exhibited few branches.Higher magnification images of these profiles (FIG. 5d,e ) revealed thatthey were condensed with large intercristae spaces and narrow junctionsbetween cristae. A number of mitochondria in tissue from patients withBD also appeared cup- or ringed shaped (FIG. 5d-h ).

BD Fibroblasts and Lymphocytes Exhibit Alterations in MitochondrialMorphology

While alterations in mitochondrial morphology in postmortem brain aresuggestive of altered mitochondrial function in BD, demonstrating adisease-specific relationship between mitochondrial morphology andaltered mitochondrial and energy metabolism requires living humantissue. Given that brain showed morphological alterations inmitochondrial shape and distribution, we next determined if, like brain,primary non-neuronal cells—fibroblasts and lymphocytes harvestedantemortem from individuals with BD—would show mitochondrialabnormalities. We used the mitochondrial—selective fluorescent markerM7510 to identify mitochondria and to examine mitochondrial structureand organization. Labeling of fibroblasts (FIG. 6a ) and lymphocytes(FIG. 6e ) from healthy control subjects revealed a predominantlydispersed network of elongated and branched mitochondria which showedconnectivity and varying degrees of fusion. The mitochondria weretypically organized around the nucleus with longer tubular networks thatextended to the plasma membrane. In comparison to all controlfibroblasts and lymphocyte lines examined, mitochondrial structurerevealed by Mitotracker 7510 staining in the BD cell lines wasdramatically altered (FIG. 6b,f ). The mitochondrial morphology in mostcells from patients with BD showed extensive perinuclear clustering,which was seen in greater than 90% of the cells. Within the clusters,mitochondria frequently appeared as punctate, cup- or ring-shapedfluorescent profiles with little branching—a finding that was observedin both lymphocytes and fibroblast cell lines regardless of the age ofthe individual. The clusters varied in size but were substantiallylarger than those in control cells. In some BD cells, long mitochondrialprofiles were retained but were fewer in number than those in controlcells and were present in the same cells displaying large mitochondrialclusters.

Given that genetic studies have implicated abnormalities inmitochondrial DNA and function in the pathogenesis of Parkinson'sdisease (PD; see e.g., Beal, Free Rad. Biol. 32:797-803 (2002), Beal,Ann. Neurol. 58:495-505 (2005), and Fahn et al., NeuroRx. 1:139-154(2004)), we examined fibroblasts from patients with PD to determine ifthese cells displayed alterations in mitochondrial structure similar tothose seen in BD. Mitochondrial profiles in fibroblasts from patientswith PD (FIG. 6c,d ) labeled with Mitotraker 7510 showed a dispersedmitochondrial distribution similar to that seen in fibroblasts fromhealthy control subjects. Unlike the healthy controls and subjects withBD, fibroblasts from individuals with PD exhibited a large degree ofmitochondrial fragmentation.

We used electron microscopy to further examine the subcellular featuresof mitochondria in BD and control cell lines. In fibroblasts andlymphocytes from healthy control subjects (FIG. 7 a,c,e) themitochondria were distributed randomly throughout the cytoplasm. Bycomparison, fibroblasts and lymphocytes from patients with BD showedcollapsed mitochondria, which were clustered close to the nucleus (FIGS.7b and d )—consistent with the light microscopic findings. Mitochondrialprofiles in these cells showed little evidence of branching. As inneurons, mitochondrial profiles in cultured cells from the subjects withBD were predominantly arranged in perinuclear clusters, in contrast tothe dispersed mitochondrial network in cells from healthy subjects (FIG.7a,b .; see also FIG. 6a,e ), and were often ring or cup-shaped, or,less frequently, circular (FIG. 7g,h ). Cristae were swollen orill-defined (FIG. 7d,f ). In contrast to the altered structure andcellular arrangement of the mitochondria in the BD cells, otherorganelles such as the plasma membrane, ER, and Golgi apparatus appearedsimilar to those in control cells.

Fibroblasts from Patients with BD do not Exhibit CytoskeletalAlterations or Apoptosis

Using F-actin selective phalloidin (red label, FIG. 8a,b ) or actinimmunocytochemistry (data not shown), we found that abnormalities inmitochondrial shape and distribution (green label, FIG. 8b-d ) were notaccompanied by cytoskeleton changes in cells from BD individuals (FIG.8b ), which showed a cytoskeletal pattern similar to that seen inhealthy controls (FIG. 8a ). In addition, fluorescent staining offibroblasts with the DNA-binding dyes DAPI or bisbenzimide (blue label),revealed no evidence of apoptosis or nuclear fragmentation in the BDcells (FIG. 8b ) compared with controls (FIG. 8a ).

Redistribution of Mitochondria in Primary Cells from BD Patients

As validation of the dramatic perinuclear accumulation of mitochondriarevealed by morphological examination of the BD cells, we examinedspatial variation in the perinuclear distribution of mitochondria innine fibroblasts from each of n=6 subjects with BD (total BD cellsanalyzed=54) and in five fibroblasts from each of n=6 healthyage-matched control subjects (total healthy cells analyzed=35). Eachsubject contributed one digital image of a randomly placed field ofview; the number of cells/image varied from 1 to 7 across subjects, withlarger numbers of cells/image in random fields from BD subjects. Weobserved that relative to the healthy controls, fibroblasts fromindividuals with BD appeared to possess higher mitochondrial densitiesas a function of radial distance from the nuclear envelope (FIG. 8e ,left). We then applied our segmentation algorithm to measure numericaldensity objectively (FIG. 8e , center). Resultant data for a cell from aBD subject (red) and a healthy control subject (blue) are displayed inFIG. 8e , right. Our ANCOVA model confirmed that average mitochondrialdensity for healthy subjects declined by −0.0004/micron (SE=0.0001,ANCOVA t−value −9.02, p<5×10⁻⁴) from the nuclear envelope but wasconstant for the BD subjects on average and with higher variability.Specifically, the BD group exhibited significantly less decline innumerical densities at perinuclear distances proximal to the nuclearenvelope than those seen in healthy subjects (SE=0.0002, ANCOVA t-value2.62, p=0.008).

Lithium Effects on Mitochondrial Structure

Mood stabilizing drugs like lithium are commonly used as treatment forBD (Friedman et al., Biol. Psychiatr. 56:340-348 (2004) and Goodwin etal., JAMA 290:1467-1473 (2003)), and all but one of our subjects with BDwas receiving lithium. Therefore, we next determined whether lithiumtreatment could promote changes in mitochondrial structure similar tothose seen in fibroblasts or lymphocytes from BD patients. Controlfibroblasts and lymphocytes were treated with 2 mM lithium carbonate(LiCO₃; approximately twice the average serum level of lithium inpatients) for 3 and 5 days. Cells treated with a water vehicle onlyserved as controls. Light microscopic examination using the fluorescentmitochondrial marker, 7510, revealed no significant differences inmitochondrial shape and distribution in cell lines exposed to LiCO₃compared to vehicle treated cells (data not shown).

Impaired Mitochondial Function with Metabolic Stress in BD Fibroblasts

To determine whether the abnormal mitochondrial morphology we observedin neurons and primary cultured cells from patients with BD waspredictive of hormonal or oxidative stress-induced functional changes inthe mitochondria, we measured two stress parameters: (1) ATP levels,using a biochemical luciferase-based assay, and (2) morphologicalchanges in mitochondrial membrane potential using the cationicfluorescent dye, JC-1, in untreated fibroblasts and in fibroblast linesexposed to either hydrocortisone or hydrogen peroxide challenge. Loss ofred JC1 signal relative to monomeric green JC1 indicates collapse ofmitochondrial membrane permeability (Smiley et al., Proc. Natl. Acad.Sci. 88:3671-3675 (1991) and Cossarizza et al., Biochem. Biophys. Res.Comm. 197:40-45 (1993)). Under basal metabolic conditions, healthyfibroblasts stained with JC1 displayed numerous dense red fluorescentaggregates, consistent with efficient mitochondria and intactmitochondrial membrane potential (FIG. 9a,c ). The green fluorescentmonomeric from of JC1 was also present in the cytosol of control cellsbut in low levels (FIG. 9a,c ). In contrast to the control fibroblasts,BD fibroblasts exhibited fewer detectable red fluorescent mitochondrialaggregates of JC1 (FIG. 8b,d ) and elevated levels of green fluorescentmonomeric JC1 in the cytoplasm (FIG. 9b,d ). Quantitative analyses ofJC-1 monomers and aggregates showed differences in the ratio of red togreen fluorescence which did not reach statistical significance.However, the determination of ATP levels using bioluminescence, revealeda 2.4-fold decrease in the levels of ATP in fibroblasts from subjectswith BD from patients compared to control fibroblasts (FIG. 8e ; Controlfibroblasts, no treatment—mean=9.02×10⁻⁴, SE 2.3×10⁻⁴; BD fibroblasts,no treatment—mean=3.8×10⁻⁴, SE 5.4×10⁻⁵; p<0.05).

Using the same techniques, we examined the role of stress-relatedresponses to mitochondrial dysfunction and energy metabolism in BD.Following 24 hr treatment with 100 μM hydrocortisone (HC), lightmicroscopic examination of mitochondria in control fibroblastsvisualized with MitoTracker 7510 showed some loss in the reticularpattern of mitochondria (FIG. 10b,c ) in treated compared to untreatedcells (FIG. 10a ). JC-1 staining of fibroblasts from healthy individualstreated with HC (FIG. 10g ) revealed loss of red mitochondrialaggregates in most cells with detectable increases in the green JC1monomeric form compared to untreated cells (compare with FIGS. 9a and c). Mitochondria from BD subjects labeled with MitoTracker 7510 andexposed to the same concentration of HC (FIG. 10e,f ) displayedperinuclear clustering like that seen in untreated cells but a greaterdegree of mitochondrial fragmentation compared to treated control cells(FIG. 10b,c ). JC1 staining of BD fibroblasts treated with HC (FIG. 10h) revealed an even greater loss of red JC1 mitochondrial aggregates aswell as a qualitative increase in JC1 monomeric green fluorescence.Despite the qualitative differences in JC1 signal seen by fluorescencemicroscopy, ratiometric changes in JC1 and differences in ATP levelsafter treatment did not reach statistical significance (data not shown).

We next examined whether increased oxidative stress would exacerbatemitochondrial energy dysfunction in BD. Control fibroblasts treated with100 μm H₂O₂ for 24 hrs exhibited dramatic changes in mitochondrialstructure. Mitochondria in cells exposed to H₂O₂ and labeled withMitoTracker 7510 (FIG. 11b,c ) showed a dispersed mitochondrial networkwith loss of elongated mitochondrial profiles, increased perinuclearclustering, and increased mitochondrial fragmentation compared tountreated cells (FIG. 11a ). These alterations in mitochondrialmorphology also were accompanied by loss of mitochondrial permeability,revealed by reduced JC1 red aggregates and increased JC1 cytosolicmonomeric staining (FIG. 11g , left panel). ATP levels measured bybioluminescence assay showed no significant difference in ATP comparedto untreated control cells. Disturbances in mitochondrial structure andfunction were enhanced in fibroblasts from patients with BD followingoxidative stress induced with H₂O₂. Fibroblasts from BD patients labeledwith MitoTracker 7510 (FIG. 11 e,f) showed almost complete loss of themitochondrial network, mitochondrial clustering and dramaticmitochondrial fragmentation (FIG. 11e,f ) compared to untreated cells(FIG. 11d ). JC1 staining revealed severe loss of mitochondrial membraneintegrity that correlated with little to no JC1 red aggregate stainingand high levels of monomeric JC1 (green) in the cytoplasm (FIG. 11g ,middle panel). The morphologic alterations in mitochondrial membranepotential seen with JC1 staining—a change consistent with collapse ofthe mitochondrial electrochemical gradient—were accompanied by a 83%decrease in ATP levels in fibroblasts from BD subjects exposed to H₂O₂compared to untreated fibroblasts (BD fibroblasts, notreatment—mean=3.8×10⁻⁴, SE 5.4×10⁻⁵; BD fibroblasts, H₂O₂treated—mean=6.2×10⁻⁵, SE 4.2×10⁻⁵, p<0.001) and a 93% decrease comparedto control cells exposed to H₂O₂ (Control fibroblasts, H₂O₂treated—mean=9.9×10⁻⁴, SE 4.3×10⁻⁴; BD fibroblasts, H₂O₂treated—mean=6.2×10⁻⁴, SE 4.2×10⁻⁵, p<0.05).

Methods Human Brain Tissue

Postmortem brain tissue five individuals ranging in age from 61-74 yearsdiagnosed with manic-depressive Bipolar Disorder, Type 1 according tothe guidelines of DSM IV (REFS) were used in this study. We also studiedan equal number of age-matched individuals ranging in age from 51-78with no known history of psychiatric illness who were evaluated usingthe same criteria. In addition, brain tissue from five cases withParkinson's Disease (PD) and five age-matched controls were examined.The PD and control group ranged in age from 68-84 years and neithergroup presented with clinical symptoms consistent with BD. Fixed BD,control and PD tissue were obtained from the Harvard Brain TissueResource Center at McLean Hospital Belmont, Mass.).

Cells

All primary human skin fibroblasts and lymphocyte lines were obtainedfrom Coriell Institute of Medical Research, Camden N.J. A total of 12fibroblast lines (n=6 Bipolar Disorder—BD; n=6 age-matched normalcontrols) and 12 lymphocyte lines (n=6 BD; n=6 controls) ranging in agefrom 20 yrs to 65 yrs old were used for the study. The diagnosis of BD(guidelines established in DSM IV) along with medication status of thesubjects was documented for each line. In addition, a second group ofhuman fibroblasts from four individuals with PD were purchased fromCoriell Institute. Age-matched control cell lines were obtained fromindividuals with no history of psychiatric illness.

Cell Culture

Fibroblast cell lines were grown in Minimal Essential Media plus 15%fetal bovine serum and 1% glutamine, penicillin streptomycin in 5% CO₂.Lymphocytes were grown in RPMI plus 15% FBS and 1% glutamine, penicillinstreptomycin in 5% CO₂. All cell culture media was from Invitrogen.Media was changed every other day. Cell lines were used between passages3 and 14.

Mitochondrial Probes

The fluorescent marker, MitoTracker-M7510 (Invitrogen, Carlsbad Calif.),was used to visualize mitochondria according to manufacturersinstructions. Briefly, fibroblasts were plated at 2.5×10⁴ and grown oncoverslips, subsequently washed one time with pre-warmed growth mediaand incubated with M7510 at a final concentration of 250 nM in culturemedia at 37° C., 5% CO₂ for 30 min. Cells were then washed once withculture media and fixed in 4% paraformaldehyde in 100 mM phosphatebuffer pH 7.4 for 15 min. Following fixation, coverslips were rinsed twotimes in PBS and mounted in Gel Mount (Biomedia).

Microscopic Analysis of Mitochondrial Membrane Potential

The cationic fluorescent dye, JC-1(5,5′,6,6′-tetrachloro-1,1′,3,3′-tetraethylbenzimidazolylcarbocyanineiodide) (Strategene, La Jolla, Calif. USA), was used to detect changesin mitochondrial membrane potential according to manufacturer'sprotocol. JC-1 reagent produces a red fluorescence (absorption/emissionmaxima=585/590 nm) after accumulation and aggregation in healthy,non-apoptotic cells with intact mitochondrial membrane potential andlocalizes to the cytoplasm as green with JC-1 monomers fluorescence(absorption/emission maxima=510/527 nm) in cells with compromisedmembrane potential. Briefly, cell lines were plated at a concentrationof 2.5×10⁴ oncoverslips and were incubated with a 1:100 dilution ofpre-warmed JC1 in growth media for 15 to 20 min at 37° C., 5% CO₂. Cellswere then rinsed once with assay buffer and mounted in PBS and analyzedimmediately on a fluorescence microscopy. The coverslips were placed onstandard microscopy slides and viewed immediately using a Zeiss Axiskop2 epifluorescence microscope.

Immunocytochemistry

Cultures grown on glass coverslips were generated for analyses byimmunolabeling. Cells on coverslips were washed three times with PBS andfixed for 20 min at room temperature with 4% paraformaldehyde, processedfor immunofluorescent labeling with actin (Sigma-Aldrich Corp., St.Louis, Mo.) as previously described (REFS). Briefly, cells were thenrinsed three times in PBS following fixation with aldehydes and blockedfor 30 min. Fibroblasts were incubated in primary antibody overnight atroom temperature with gentle rocking. Cells were then washed three timeswith diluting buffer followed by incubation in fluorescent-conjugatedsecondary antibodies for 2 to 3 hrs at room temperature. Coverslips weremounted and examined using a Zeiss epifluorescent microscope. In someexperiments, cytoskeletal integrity was examined using phalloidin 568was added to the secondary antibody at a dilution of 1:200 for anadditional 30 min. Cells were then washed 2 times with PBS and mountedin gel mount that contained either 4′,6-diamidino-2-phenylindole (DAPI)at a final concentration of 1×10⁴ or bisbenzimide (Hoechst 33258) (5μg/ml) for visualization of nuclear changes indicative of apoptotis.

Determination of ATP Levels

ATP production was measured in cultured fibroblast lines using the RocheATP Bioluminescence assay kit CLSII following the manufacturer'sprotocol (Roche Diagnostics, Mannheim, Germany). Briefly, cells wereplated at a concentration of 2.5×10⁵ cells per 60 mm dish were used foreach experiment and experiments were conducted two days later. Celllysis was achieved by boiling in lysis solution (100 nM Tris, 4 mM EDTA,pH=7.75) followed by incubation for 2 min at 100° C. The cells then werecentrifuges spun at 1000×g for 1 min. The supernatants were used fortotal cell ATP determination. Samples were run in triplicate on a96-well plate MLX luminometer (Dynex Technologies, Chantilly, Va., USA).Integration was delayed for 1 sec after the addition of luciferase andluminescence was measured for 10 seconds at an emission maximum of 562nM. Following ATP luminescence measurements, data was normalized toprotein concentration as determined by the method of Bradford (BradfordDC assay, BioRad, Temecula, Calif., USA) to yield nanograms of ATP permg of protein. Assays were performed in triplicate.

Statistical Analysis of Mitochondrial Distribution Using Digital Images

For each cell in each digital image, we traced inner and outer cellularboundaries manually. The inner cellular boundary was defined to coincidewith the nuclear envelope and the outer boundary was defined to containall mitochondria within the spatial extent of the fibers surrounding thenucleus. No overlap was allowed between outer boundaries for differentcells. For each cell, a set of concentric, equally-spaced scaled copiesof the inner boundary was placed at the nuclear centroid to defineexpanding annuli that covered the entire irregularly shaped spacebetween inner and outer boundaries. We then employed a segmentationalgorithm (Young et al., Biostatistics 2:351-364 (2001)) to quantifymitochondria within each annulus. As a potential discriminator betweenbipolar and healthy cells, we defined mitochondrial numerical densitywithin each annulus as the ratio of the sum of the areas ofmitochondrial clusters to total annular area (Weibel, “StereologicalMethods,” Vol. 2. Theoretical Fundations. Academic Press, London (1980)and Baddeley et al., “Stereology for statisticians,” Chapman & Hall/CRC(2005)). We employed a mixed effects analysis of covariance model forformal statistical analysis. Our model included an overall interceptterm, a BD versus healthy control grouping factor, perinuclear distanceand a group by distance interaction. Cells were treated as nested withinimages that were nested within subjects and numerical density wasre-expressed on the logarithmic scale to conform to the constantvariance and Gaussian distribution properties of the general linearmodel.

Hydrocortisone-Induced Stress

Fibroblasts (n=6) and lymphocytes (n=6) from patients with BD andage-matched controls (Fibroblasts, n=6; lymphocytes, n=6)) were exposedto hydrocortisone to induce mitochondrial stress (REFS). Hydrocortisone(Sigma H0888, St. Louis, Mo., USA) was dissolved in 50% ethanol/50%culture medium to yield a 40 mM stock solution. Hydrocortisone was thendiluted to appropriate experimental concentrations (10 nM, 1 uM, 100 uM)with above described growth media. Confluent (85-95%) fibroblasts andlymphocytes (1×10⁵-1×10⁶) were treated for 24 hr with hydrocortisone(sub-acute stress). Cells treated with vehicle (25% ethanol) aloneserved as controls. Following hydrocortisone treatment, fibroblasts wereexamined for alterations in mitochondrial morphology, membranepotential, and ATP levels, as described above. All experiments wereperformed in triplicate.

Oxidative Stress

We also studied an equal number of fibroblast lines from BD andage-matched controls which were exposed to 100 μM hydrogen peroxide for24 hrs (REFS). ATP levels were assayed as described above. Lightmicroscopic analysis of JC1 to determine changes in mitochondrialmembrane potential also were performed as previously described.

Other Embodiments

All publications, patents, and patent applications mentioned in thisspecification are herein incorporated by reference to the same extent asif each independent publication or patent application was specificallyand individually indicated to be incorporated by reference.

While the invention has been described in connection with specificembodiments thereof, it can be understood that it is capable of furthermodifications and this application is intended to cover any variations,uses, or adaptations of the invention following, in general, theprinciples of the invention and including such departures from thepresent disclosure that come within known or customary practice withinthe art to which the invention pertains and may be applied to theessential features hereinbefore set forth, and follows in the scope ofthe claims.

Other embodiments are within the claims.

What is claimed is:
 1. A method for enhancing cardiac or cardiovascularfunction in a human subject in need thereof, said method comprisingadministering to said subject a pharmaceutical composition comprisingisolated and substantially pure mitochondria in an amount sufficient toenhance said cardiac or cardiovascular function.
 2. The method of claim1, wherein said mitochondria are syngeneic mitochondria.
 3. The methodof claim 1, wherein said mitochondria are allogeneic mitochondria. 4.The method of claim 1, wherein said mitochondria are administeredsystemically. 5.-6. (canceled)
 7. The method of claim 1, wherein saidmitochondria are administered locally into cardiac muscle.
 8. The methodof claim 1, wherein the isolated and substantially pure mitochondria areadministered in an amount sufficient to increase the respiratory abilityof a heart cell in the subject. 9.-10. (canceled)
 11. The method ofclaim 4, wherein the isolated and substantially pure mitochondria areadministered in an amount sufficient to increase the respiratory abilityof a heart cell in the subject.
 12. The method of claim 7, wherein theisolated and substantially pure mitochondria are administered in anamount sufficient to increase the respiratory ability of a heart cell inthe subject.
 13. The method of claim 1, further comprising administeringto said subject an agent selected from vitamin A, vitamin C, vitamin D,vitamin E, vitamin K, folic acid, choline, vitamin B1, vitamin B2,vitamin B5, vitamin B6, vitamin B12, biotin, nicotinamide, betacarotene,coenzyme Q, selenium, superoxide dismutase, glutathione peroxide,uridine, creatine succinate, pyruvate, dihydroxyacetone,acetyl-L-carnitine, alpha-lipoic acid, cardiolipin, omega fatty acid,lithium carbonate, lithium citrate, calcium, and mixtures thereof.14.-15. (canceled)
 16. The method of claim 1, wherein the subject has aheart that is ischemic. 17.-18. (canceled)
 19. The method of claim 4,wherein the subject has a heart that is ischemic.
 20. The method ofclaim 7, wherein the subject has a heart that is ischemic.
 21. Themethod of claim 1, wherein the mitochondria are isolated frommarrow-derived adult progenitor cells, stem cells, precursor cells, orskeletal muscle cells. 22.-23. (canceled)
 24. The method of claim 4,wherein the mitochondria are isolated from marrow-derived adultprogenitor cells, stem cells, precursor cells, or skeletal muscle cells.25. The method of claim 7, wherein the mitochondria are isolated frommarrow-derived adult progenitor cells, stem cells, precursor cells, orskeletal muscle cells.
 26. The method of claim 1, wherein the humansubject has an ischemic heart tissue, and wherein said method compriseslocally administering to said heart tissue a pharmaceutical compositioncomprising isolated and substantially pure syngeneic mitochondria in anamount sufficient to enhance cardiac or cardiovascular function of saidsubject.
 27. The method of claim 26, wherein the isolated andsubstantially pure syngeneic mitochondria are administered in an amountsufficient to increase the respiratory ability of the heart cell ortissue.
 28. The method of claim 26, wherein the mitochondria areisolated from skeletal muscle.
 29. The method of claim 26, furthercomprising administering to said subject an agent selected from vitaminA, vitamin C, vitamin D, vitamin E, vitamin K, folic acid, choline,vitamin B1, vitamin B2, vitamin B5, vitamin B6, vitamin B12, biotin,nicotinamide, betacarotene, coenzyme Q, selenium, superoxide dismutase,glutathione peroxide, uridine, creatine succinate, pyruvate,dihydroxyacetone, acetyl-L-carnitine, alpha-lipoic acid, cardiolipin,omega fatty acid, lithium carbonate, lithium citrate, calcium, andmixtures thereof.
 30. The method of claim 26, wherein the pharmaceuticalcomposition is administered by local injection into cardiac muscle.